J Korean Med Sci.  2020 Dec;35(48):e430. 10.3346/jkms.2020.35.e430.

Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms

• Wang JM
• Chen QX

• KMID: 2509532
• DOI: http://doi.org/10.3346/jkms.2020.35.e430

Abstract

Background
Intraprocedural rupture (IPR) is a devastating complication in endovascular treatment of ruptured intracranial aneurysms, but its risk factors have not been fully assessed. This study was performed to explore the risk factors for IPR during embolization of ruptured cerebral aneurysms.
Methods
A total of 1,494 patients with ruptured intracranial aneurysms who underwent endovascular interventional embolization were enrolled. Clinical characteristics were collected for each patient. Univariate and multivariate logistic regression analysis was employed to identify the factors independently associated with IPR. A receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of continuous variables predicting IPR.
Results
Forty-one patients suffered from IPR (2.7%). Multivariate logistic regression analysis indicated that aneurysm size (odds ratio [OR], 0.819; 95% confidence interval [CI], 0.732–0.916), aneurysms with irregular morphology (OR, 2.162; 95% CI, 1.143–4.091), time from symptom onset to intervention (OR, 1.615; 95% CI, 1.207–2.161), and vasospasm during embolization (OR, 2.021; 95% CI, 1.038–3.934) were the independent risk factors of IPR. ROC curve analysis showed that the area under the curve for aneurysm size and time from onset to intervention were 0.697 (cutoff value, 3.4 mm; sensitivity, 78.8%; and specificity, 53.7%) and 0.659 (cutoff value, 2 days; sensitivity, 78.0%; and specificity, 45.2%), respectively.
Conclusion
Aneurysms with irregular morphology, aneurysms ≤ 3.4 mm in diameter, time from onset to intervention > 2 days and cerebral vasospasm during embolization are independent risk factors for IPR during coil embolization of ruptured aneurysms. More attention should be paid to the factors increasing the risk of IPR in patients with ruptured aneurysms so as to minimize this complication.

Keyword

Aneurysm; Embolization; Intraprocedural Rerupture; Risk factors

Figure

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  Fig. 1 The ROC curves for aneurysm size and time from onset to intervention. (A) The cutoff level of the aneurysm size for IPR. The cutoff level of 3.4 mm shows a sensitivity of 78.8% and a specificity of 53.7%. The AUC is 0.697. (B) The cutoff value of the time from onset to intervention for IPR. The cutoff level of 2 days shows a sensitivity of 78.0% and a specificity of 45.2%. The AUC is 0.659.ROC = receiver operating characteristic, IPR = intraprocedural rerupture, AUC = area under the curve.

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